Provider Demographics
NPI:1518386499
Name:ZHAO, JASON YAOU (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:YAOU
Last Name:ZHAO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:YAOU
Other - Last Name:ZHAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1405 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4534
Mailing Address - Country:US
Mailing Address - Phone:302-345-0015
Mailing Address - Fax:
Practice Address - Street 1:6767 29TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5474
Practice Address - Country:US
Practice Address - Phone:970-652-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60531225100000X
COPTL.0017689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500670424Medicaid
ORR186741Medicare PIN
OR500670424Medicaid
ORR186268Medicare PIN